The Obama Administration has proposed a massive federal program aimed at curbing the use of psychotropic medications to treat foster youths, an issue that appeared on the federal radar in 2011.
President Barack Obama included in his 2015 budget a plan for a 10-year plan that could allocate up to $750 million in federal dollars to “address over-prescription of psychotropic medications for children in foster care.”
The two-pronged plan focuses mostly on building the ability of state’s to treat foster youths without psychotropic drugs – or at least with less drugs – and then rewarding states for lowering reliance on the drugs.
The first part is a $50 million a year, five-year investment by the Administration for Children and Families (ACF). That mandatory spending would “encourage the use of evidence-based screening, assessment and treatment of trauma and mental health disorders” among foster youth.
The second part is a $500 million Medicaid demonstration program that would provide performance-based Medicaid incentive payments to “improve care coordination and delivery for children and youth in foster care through increased access to evidence-based psychosocial interventions.”
National attention to the high rate of psych meds prescriptions for foster youths was fueled by the shocking 2009 suicide of a seven-year-old in Florida named Gabriel Myers. The little boy had been prescribed a number of potent mind-altering drugs during his childhood, and hung himself at the home of his foster parents.
A 2011 Government Accountability Office (GAO) study reviewed nearly 100,000 foster children in five states – Florida, Massachusetts, Michigan, Oregon and Texas – found thousands of children on psychiatric medications, many at higher doses than are approved by the Food and Drug Administration.
Hundreds of these children were prescribed five or more drugs at the same time, a mixture of medications that has never been proven effective and which significantly increases the potential for side effects.
The GAO recommended that the Department of Health and Human Services “consider endorsing guidance for states on best practices for overseeing psychotropic prescriptions for foster children.”
The ACF did convene behavioral health leaders from around the country to discuss the issue in 2012, but HHS has yet to issue a formal guidance.
Just before the GAO report was released in 2011, HHS leaders also sent a letter to state Medicaid and child welfare directors instructing them to begin reporting on psychotropic use to ACF in an Annual Progress and Services Report. The report is supposed to include “comprehensive descriptions of procedures and protocols planned or in place to ensure the safe and appropriate use of psychotropic medications,” according to the letter.
The HHS letter highlighted the fact that nearly half of foster youth in group or residential homes “are taking at least one psychotropic,” and that the “majority of children in foster care receiving psychotropic medications have multiple prescriptions.”
There is a dearth of information about how effective psychotropics are for kids, the letter says, and “scant evidence of the effectiveness of treatment with multiple medications.”
John Kelly is the editor-in-chief of The Chronicle of Social Change